Healthcare Provider Details

I. General information

NPI: 1679536429
Provider Name (Legal Business Name): SHANNON L ROBINSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 HIGHWAY 441 S
CLAYTON GA
30525-5423
US

IV. Provider business mailing address

896 HIGHWAY 441 S
CLAYTON GA
30525-5423
US

V. Phone/Fax

Practice location:
  • Phone: 706-782-5991
  • Fax: 706-782-5111
Mailing address:
  • Phone: 706-782-5991
  • Fax: 706-782-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN154343NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: